Long-term services and supports (LTSS) manual

Home and Community Based (HCB) waivers and programs using HCB waiver rules

Revised Date: 
July 1, 2015

Purpose: This section gives a brief overview of the Home and Community Based (HCB) Waivers authorized by Home and Community Services (HCS) or Developmental Disabilities Administration (DDA).

HCB Waivers is an institutional program under Section 1915(c) of the Social Security Act. HCB Waivers provide alternatives to placement in a medical institution. These alternatives include remaining in their own home or in an alternate living facility.

Note: Clients must be aged, blind, or disabled to receive HCS CN Waiver services and eligible under medical coverage group L21 for SSI recipients, L22 for SSI related recipients, S08 Health Care for Workers with Disabilities (HWD) or D01 Foster Care.

HCB Waivers authorized by HCS:

  • Community options program entry system (COPES)
  • New Freedom consumer directed services (New Freedom)
  • Residential Support Waiver (RSW)

Programs that use HCB Waiver financial eligibility rules but are not a HCB Waiver:

  • Roads to Community Living (RCL)
  • Program of all-inclusive care for the elderly (PACE)
  • Hospice as a program

HCB Waivers authorized by DDA:

Clarifying Information:

Clients needing the rules of a HCB Waiver in order to be eligible for a categorically needy (CN) program to access Community First Choice are subject to all the initial and post-eligibility rules in the HCB Waiver.

A Comprehensive Assessment, is the functional assessment (also called a CARE assessment) completed by HCS or DDA staff for all clients to determine initial or ongoing HCB Waiver eligibility. A client attains institutional status under WAC 182-513-1320 when he or she receives HCB Waiver services.

Worker Responsibilities

  1. Eligibility Determination Process
    1. Determine both financial need and functional need.
    2. Complete both eligibility determinations concurrently.
    3. Both financial and functional eligibility must be determined before you authorize HCB Waiver services.
    4. Eligibility rules for HCS HCB Waivers.
    5. Eligibility rules for DDA HCB Waivers.
  2. Staff Who Make Eligibility Determinations:
    1. The HCS social worker or DDA case manager determines the functional eligibility using CARE, and authorizes the long-term services and supports.
    2. The HCS social worker or DDA case manager notifies the financial worker of the start date of service, type of service, living arrangement, daily rate if in a ALF, address if placed in a facility and any other pertinent changes using the barcode 14-443 for HCS and the barcode 15-345 for DDA. The FSS determines the client’s financial eligibility for medical care and post eligibility (determination of participation) to the HCS Waiver program. The financial worker notifies the HCS social worker or the DDA case manager using the 07-104 formerly the 65-10 in barcode, that the client meets financial eligibility.
    3. The client authorized services must pay their responsibility toward the cost of care (service participation and room and board) to the provider or provider agency.

Note: A client can be authorized to receive Hospice services while on HCB Waiver services. The HCB program (usually COPES) is the priority program. Any participation is applied toward the HCB Waiver provider. For more information see Hospice index.
A client can be authorized to receive a HCB Waiver, Community First Choice and Hospice. The participation is applied toward the HCB Waiver and CFC provider before it is applied to the Hospice provider.